Re-recognition of Membrane Theory of Ontogenetic Anatomy

Based on developmental anatomy, the “compartment” theory emphasizes that the spread of tumor cells is not random and directionless. Instead, tumor cells reside for an extended period within the same embryonic origin (primordial) compartment, also referred to as a morphogenetic unit, within the tissue. Due to the inhibitory effect of boundaries, tumor cells find it challenging to cross the boundaries of the “compartment” [1]. Then, German gynecologist Dr. Höckel pioneered the complete mesometrial resection (TMMR) for cervical cancer. This procedure involves thorough removal of the entire uterus and proximal vaginal, following the principles of the “Mullerian embryological” origin, with a strong emphasis on achieving complete tissue boundary resection in surgical specimens. This approach differs from the traditional anatomical approach, which primarily focuses on morphological structures [2–4]. Due to the development process in the human embryo, such as the “Mullerian embryonic” development, mesenchyme originating from the lateral mesoderm forms membranes surrounding each “embryonic origin,” eventually creating “membrane planes” and “intermembrane spaces.” As a result, precise surgical techniques for identifying and dissecting the membrane planes and intermembrane spaces between different embryonic origins have emerged [5]. Membrane anatomy surgery offers a more precise and comprehensive understanding compared to previous approaches such as “space anatomy” or “plane-based structure anatomy.” It emphasizes the significance of anatomical landmarks and features, enabling gynecologists to navigate various surgical membrane planes with enhanced precision and accuracy.